Although even the Affordable Care Act’s staunchest supporters say there will be glitches in the system, it is designed to connect millions of uninsured or under-insured Americans with access to medical care.

Meanwhile, a Madison doctor has is trying to pioneer a system that aims to fill in some gaps. Doctor Will Schupp opened a clinic around six weeks ago that employs “direct primary care”.

Madison doctor Will Schupp, M.D.

Credit courtest Dr. Will Schupp

It's an economic model, Schupp says, that differs quite a bit from the way medicine is typically practiced in this country. "The basis of the practice is structured differently, based on the way I get paid. "

In a typical practice, everything is done on a fee-for-service basis - patients come in for an office visit, and that visit, along with other services like lab work, are billed through the insurance company. "In my case," Schupp says, "I remove that as the means for healthcare and instead people pay a subscription fee directly to me, and I keep it low by not billing insurance. And then I can take care of them all the time."

Schupp says patients come out ahead for other services, as well.

"Labs usually cost about $6 to $14 at cost, but they're usually billed out from $80 up to $215. So I just have [his patients] pay the actual cost of the lab instead of the insurance price, and it makes it affordable for them." - Dr. Will Schupp

The practice is believed to be the first of its kind in Wisconsin. It's based in part on a system called "concierge medicine," in which doctors work directly with generally wealthy patients for a substantial subscription fee. Schupp sees his clientele as being at a much lower end of the economic spectrum, even as health care reform goes into effect.

"A lot of my patients who either have no insurance or high-deductable insurance - people who essentially have to pay full price for their medical care - usually avoid getting it. Or they get some, and don't go back for the follow-up," Schupp says. "And that was really a problem, in my opinion."

Schupp says his model also allows him to cap the number of patients he sees, allowing him greater professional satisfaction and his patients better access. He hopes, as the Affordable Care Act is phased in, that he will someday be able to compete for business through Wisconsin's health exchange.